The incidence and characterisation of hospitalised acute spinal trauma in Taiwan—A population-based study

Abstract

The purpose of this study was to perform a cross-sectional population-based study of hospitalised cases due to acute spinal trauma in Taiwan, based on information from the nationwide National Health Insurance (NHI) database. To calculate the annual incidence of hospitalised acute spinal trauma, evaluate the distribution of neurological injury and its surgical intervention, and analyse the use of medical resources and related factors in Taiwan, the entire inpatient datasets were selected between 2000 and 2003 for use in the present study. There were 13,371, 13,800, 13,728 and 13,585 cases identified in 2000, 2001, 2002 and 2003, respectively, the average incidence of hospitalised acute spinal trauma in Taiwan was 61.61/100,000, and it was similar in both genders (rate ratio of male to female: 0.99). There was a significant trend of increased incidence with increasing age in both genders, particularly after the age of 60. The decreasing incidence rate ratios of neurological deficit to neurological intactness are 0.75, 0.58, 0.45, 0.26 and 0.16 in the age strata of 0-19, 20-39, 40-59, 60-79 and 80 or more years, respectively. In general, the operation rate is only 17.3% of all acute spinal injury cases, but it would be up to a significant 29.5% if the patients had spinal fractures with neurological insufficiency. There is an obvious decreasing trend of operation rate in spinal bony trauma with age, but a reverse trend is noted in the group with spinal nerve injury without spinal fracture. Finally, the enrolled subjects of acute spinal injuries spent $NT 43336.3+/-80270.2 (equal to US$ 1313+/-2432) and stayed for 8.5+/-8.9 days in hospital. The above two variables of hospitalised medical utilisation are significantly different when considering gender, neurological status, and surgical intervention or not. Noticeably, if operative treatment for acute spinal injury is necessary, the LOS would increase by two times and the medical cost by six times. In Taiwan, the annual incidence of hospitalised acute spinal injuries was higher but the direct cost was much lower. The characterisation of gender ratio, neurological condition, and surgical performance had been significantly effected by age.